Saturday, 27 April 2019

Proforma / Puberphonia/ followed in SIVA ENT Hospital

Proforma / Puberphonia/ followed in SIVA ENT Hospital
1. Name
2. Age
3. Family history
4. Study
5. Work
6. Marriage
7. Children
8. Happy with parents
9. Happy with wife(family)
10. Happy with neighbors
11. Age at presentation OF 1st symptom. How he recognized
12. Gender on phone
13. Presenting complaints( at first visit )
The voice qualities associated with puberphonia include:
• high pitch
• low intensity
• breathlessness
• breaks in phonation and frequency
• neck and throat tension
Emotional stress
• Delayed development of secondary sex characteristics
• Resistance to pubertal changes
• Self-consciousness resulting from an early breaking of the voice
• Self-consciousness resulting from emerging adulthood
• Excessive admiration of another male or sibling
• Excessive maternal protection
Organic causes of Puberphonia include:
• Laryngeal muscle tension which then causes laryngeal elevation
• Muscle In coordination
• Congenital anomalies of the larynx
• Vocal fold asymmetries
• Unilateral vocal fold paralysis
• Non fusion of the thyroid laminae. When this is the case, it is important that hypogonadism is ruled out, as this may be the cause.
• Puberphonia may be related to the larynx or an undeveloped natural tenor voice, changes in hormonal development, congenital anomalies of the larynx and vocal fold asymmetries, minor structural changes (particularly the sulcus), unilateral vocal fold paralysis, laryngeal diaphragm, debilitating disease during puberty, neurological disease with hypotonia, in coordination of the vocal folds, deep breathing or hearing impairment (
a) respiratory distress
14. Total number of doctors/speech therapist seen to date
15. Surgery done– yes/ no
The stroboscopic evaluation provided measures of vibratory behavior of the vocal folds such as presence or absence of mucous wave, vibratory symmetry, and amplitude; type of glottic closure; hyper function; arytenoids movement and symmetry; ventricular movement, etc. Stroboscopy also yielded a measure of the patient's fundamental frequency during sustained phonation.
Therapy tried
ENT Surgeon
Speech therapy
Other therapy
12. Ancillary treatment,Tonsillectomy etc
GRBAS scale.
GRBAS (Grade, Roughness, Breathlessness, Asthenia, Strain) scale.
measurement of the maximum phonation time (MPT).Interpreting MPT. Typically, with no laryngeal pathology, adult males can sustain vowel sounds for between 25-35 seconds and adult females between 15-25 seconds.
This scale consists of judgment of voice quality on the basis of Grade (G), Roughness (R), Breathless (B), Asthenia (A), and Strain (S) in voice production. The severity was graded on a 4-point rating scale, on which 3 being worst and 0 being normal.
13. General distress

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